Provider Demographics
NPI:1801180740
Name:FESSLER, KENNETH (DC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:FESSLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 STANHOPE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2706
Mailing Address - Country:US
Mailing Address - Phone:973-405-3872
Mailing Address - Fax:
Practice Address - Street 1:63 BEAVERBROOK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1440
Practice Address - Country:US
Practice Address - Phone:973-305-8830
Practice Address - Fax:973-305-8818
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03636111N00000X
NJC53544225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No111N00000XChiropractic ProvidersChiropractor